Field Notes

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Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

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Luise Kazda, Katy Bell, Rae Thomas, Kevin McGeechan, Rebecca Sims, and colleagues published this systematic scoping review in JAMA Network Open in April 2021. It is the first comprehensive appraisal of the evidence for and against ADHD overdiagnosis in young people, and it reaches a positive finding rather than a call for more research.

The repository downloader received HTTP 403 from the publisher, so this card records the review from its abstract and the article’s open-access full text rather than a local snapshot.

Method

The review applies a published five-question framework for establishing whether a condition is overdiagnosed, asking in sequence whether there is potential for increased diagnosis, whether diagnoses actually increased, whether the additional cases are mild or low-risk, whether those cases are treated, and whether the harms of diagnosis outweigh its benefits for that group. It synthesises 334 studies, 273 of them primary research.

Findings

The authors conclude that “this review found evidence of ADHD overdiagnosis and overtreatment in children and adolescents,” and locate the problem at a specific margin rather than across the board: “for individuals with milder symptoms in particular, the harms associated with an ADHD diagnosis may often outweigh the benefits.”

On relative age, the review reports that eleven of twelve studies found the youngest children in a class more likely to be diagnosed.

Why it matters here

The finding is what converts the relative-age gradient from a curiosity into a diagnosis-quality problem, and it supplies the direction that the gradient alone cannot: the additional cases are concentrated among mild presentations, which is the signature of overdiagnosis rather than of better case-finding. The ADHD relative-age effect carries that argument, along with the cross-diagnosis evidence that constrains it.

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